Factors Affecting Quality of Sleep in Intensive Care Unit

Background: The etiology of sleep disruption in intensive care unit is poorly known and often ignored complication. It is caused by the environmental factors especially pain, noise, diagnostic testing and human interventions that cause sleep disruption. Light, medications and activities related to patient care interfere with patient's ability to have good sleep. There are multi-factorial environmental etiologies for disruption of sleep in ICU. Objective: The objective of this study was to evaluate the factors disturbing the sleep quality in intensive care unit (ICU) admitted patients. Methodology: A cross sectional study was designed involving 150 patients admitted in intensive care unit and high dependency unit of Gulab Devi Chest Hospital. The duration of study was from September 2015 to March 2016. The questionnaire was made and filled with the help of patients. The data was analyzed using SPSS version 16.00. Results: Mean age of patients was 50.46+10.96 with maximum age of 65 and minimum age of 30 years. There was 53.33% male patients and 46.67% females participating in this study. The sleep quality was significantly poor in ICU than at home. After analysis, 54.67% patients were with poor quality of sleep due to pain and 48.67% were due to noise of environmental stimuli. The other factors were alarms, light and loud talking. Conclusion: Current study shows that reduced sleep quality is a common problem in ICU with multi-factorial etiologies. Patient reported the poor sleep quality in ICU due to environmental issues that are potentially modifiable. Conclusion: Current study shows that reduced sleep quality is a common problem in ICU with multi-factorial etiologies. Patient reported the poor sleep quality in ICU due to environmental issues that are potentially modifiable

The Effect of Magnetic Field Tilt and Divergence on the Mass Flux and Flow Speed in a Line-Driven Stellar Wind

We carry out an extended analytic study of how the tilt and faster-than-radial expansion from a magnetic field affect the mass flux and flow speed of a line-driven stellar wind. A key motivation is to reconcile results of numerical MHD simulations with previous analyses that had predicted non-spherical expansion would lead to a strong speed enhancement. By including finite-disk correction effects, a dynamically more consistent form for the non-spherical expansion, and a moderate value of the line-driving power index $\alpha$, we infer more modest speed enhancements that are in good quantitative agreement with MHD simulations, and also are more consistent with observational results. Our analysis also explains simulation results that show the latitudinal variation of the surface mass flux scales with the square of the cosine of the local tilt angle between the magnetic field and the radial direction. Finally, we present a perturbation analysis of the effects of a finite gas pressure on the wind mass loss rate and flow speed in both spherical and magnetic wind models, showing that these scale with the ratio of the sound speed to surface escape speed, $a/v_{esc}$, and are typically 10-20% compared to an idealized, zero-gas-pressure model.Comment: Accepted for publication in ApJ, for the full version of the paper go to: http://www.bartol.udel.edu/~owocki/preprints/btiltdiv-mdotvinf.pd

Intracranial Hemorrhage Due to Secondary Hypertension from Intracranial Large Vessel Occlusion

Simultaneous hemorrhagic and ischemic strokes have been previously reported in the literature. Typically, these occur in patients secondary to dialysis, cerebral amyloid angiopathy, or thrombotic thrombocytopenic purpura.1,2,3 However, this is the unique case of a 62-year-old Asian female who presented with a hemorrhagic stroke suspected to be secondary to refractory hypertension from intracranial large vessel atherosclerotic flow limiting stenosis, with rapid subsequent large vessel occlusion and ischemic stroke. Questions arise such as ideal blood pressure parameters for dual management, timeliness of computed tomography angiography imaging in the emergency department for detection of large vessel occlusion during intracranial hemorrhage, and subsequent selection of treatment plan in the dual-lesion patient population

Joint Planck and WMAP Assessment of Low CMB Multipoles

The remarkable progress in cosmic microwave background (CMB) studies over past decade has led to the era of precision cosmology in striking agreement with the $\Lambda$CDM model. However, the lack of power in the CMB temperature anisotropies at large angular scales (low-$\ell$), as has been confirmed by the recent Planck data also (up to $\ell=40$), although statistically not very strong (less than $3\sigma$), is still an open problem. One can avoid to seek an explanation for this problem by attributing the lack of power to cosmic variance orcan look for explanations i.e., different inflationary potentials or initial conditions for infl ation to begin with, non-trivial topology, ISW effect etc. Features in the primordial power spectrum (PPS) motivated by the early universe physics has been the most common solution to address this problem. In the present work we also follow this approach and consider a set of PPS which have features and constrain the parameters of those using WMAP 9 year and Planck data employing Markov-Chain Monte Carlo (MCMC) analysis. The prominent feature of all the models of PPS that we consider is an infra-red cut off which leads to suppression of power at large angular scales. We consider models of PPS with maximum three extra parameters and use Akaike information criterion ($AIC$) and Bayesian information criterion ($BIC$) of model and Bayesian information criterion ($BIC$) of model selection to compare the models. For most models, we find good constraints for the cut off scale $k_c$, however, for other parameters our constraints are not that good. We find that sharp cut off model gives best likelihood value for the WMAP 9 year data, but is as good as power law model according to $AIC$. For the joint WMAP 9+Planck data set, Starobinsky model is slightly preferred by $AIC$ which is also able to produce CMB power suppression up to $\ell\leq30$ to some extent.Comment: 27 pages, 10 figures, 3 tables, matches with the published version, abstract is shortened to keep it within arXiv's limit (1920 characters